We picked up in this later session from where the OT left off in the last hour. Santino finished working with Discovery Putty. He successfully identified 6 out of 12 farm objects (50%), and returned them to the can. When asked to repeat this, however, to determine if he could perform at greater than chance level, he was no longer attentive to the task, even with prompts. Santino was given an opportunity to spend 15 minutes outside in the play area. We began the time watering some plants; Santino was afforded assistance to complete the task requirements. He then enjoyed exercising on a large exercise ball, permitted me to assist him in a forward roll, and giggled with amusement and delight during the exercise. We finished up by assembling a 6 piece wild animal puzzle, identifying the animals as we went along. This activity strengthens object identification skills, bi-manual and fine motor dexterity, and promotes language development. Next, we went indoors and proceeded to the sink to wash our hands. Santino needed some help dispensing soap as this action requires a more complex sequence of bi-manual coordinated movements, but he clearly demonstrated that he understands the expectations of the task, requiring assistance with the physical requisites to complete it. Upon returning to the classroom, Santino requested a drink from the food and beverage options with which he was presented. I helped him pour a shake into his bottle and he drank some of it prior to leaving with his mother.

I escorted Santino into the school today having arrived early and spotting him sitting in the car with Ingrid. He cooperated by putting on his backpack, taking my hand, and proceeding to the classroom. I had prepared a bag of different games and activities and Santino selected Mr. Potato Head first. We removed the body parts and Santino watched as I identified the eyes, hands, arms, and hat. We then identified the body parts on the toy and on ourselves together and placed them onto the corresponding parts on the toy. Santino enjoyed this activity and remained engaged for 4 - 5 minutes; he correctly placed the eyes into the corresponding holes on the potato head independent of prompts but required prompts and refocusing to manipulate the other pieces properly. Santino and I then used some musical instruments to make sounds and copy rhythms. When I subsequently offered Santino a choice between two puzzles, he selected a farm puzzle, which has 7 pieces, and he correctly identified the pig upon request, independently. However, prompting techniques remained necessary for the other animals as he concentrated his attention solely on the pig. Once refocused, Santino listened to "The Wheels on the Bus" and repeated a few phrases. He did not imitate the actions demonstrated for him as we sang along, but he did wish to hear it repeatedly and began skipping along to the music. Santino watched 'Little Baby Bum' on the computer. He repeated the name after I asked him if he wanted to watch it. A few other songs were played on this application, such as 'Patty Cake', 'One Potato,' 'This Little Piggy,' 'If You’re Happy and You know it,' and 'Hickory Dickory Dock.' Santino spontaneously repeated some of the words and phrases as they played. We also referred to Mr. Potato Head whenever that song was played to facilitate object identification. He was encouraged to do act out the lyrics when listening to 'If You're Happy and You Know It, but prompting techniques remained necessary for task completion.' Overall, Santino was cooperative today and seemed especially engaged and motivated by musical activities. He is going to be seen by Christina, for OT, and then I will return for another hour session with him afterwards.

Santino was finishing up his session with Lynn. As soon as he saw me enter the classroom, he grabbed his bottle from his book-bag, indicating he wished to drink. I put the three options available in front of him and he selected the PediaSure. In efforts to foster more independent self-help behaviors, I chained the sequence of actions involved in drinking in the hopes it would elicit an anticipatory response. If Santino wanted to drink enough, he would attempt to open the bottle and pour in the liquid. The words 'open' and 'stop' were rhythmically repeated as I poured the liquid into the bottle to help Santino connect the words with the sequencing of actions. However, he presented the bottle back to me and did not initiate self-feeding behaviors. Instead, Santino presented me with the organic nutrition shake (juice). I then narrowed the choices and asked Santino which he wanted to drink, the green drink (juice) or the blue drink (PediaSure vanilla shake). He chose the blue when presented with the choice of only two options (PediaSure), clearly making his needs known. Given this simpler sequence. Santino did not demonstrate any interest when his communication board was used to facilitate language. He did not utilize the communication board to either point to a picture of a drink or to point to the yes/no option. Again, the behavioral technique of chaining was used to connect, or chain, the different steps involved in the act of pouring oneself a drink: opening the bottle, twisting off the cap, and pouring the liquid into the bottle. Santino appeared more focused when this was done a second time, possibly because his motivation (to drink) was greater. With some physical prompts, Santino twisted off the top of the shake and together we poured it into his bottle. He was reinforced verbally for the greater effort to help himself with this task. Santino did not wish to participate in the marble run game today and vocalized his displeasure when this was taken out. As we were in his original classroom and the children from the science camp were returning to occupy the space temporarily, we remained in the room while the children attempted to socialize with him and engage his attention. As he had not eaten in his earlier session with Lynn, I again presented Santino with his Fruit Loops cereal and with minimal assistance he opened it and sat on the floor to eat. I allowed him to view some videos and he happily navigated my phone and listened to 'The Wheels on the Bus." Some of the children sang along and Santino would occasionally repeat a word or phrase from the song. He did not imitate any of the actions we paired to the words, such as the movement of the windshield wipers or the turning of the wheel. After listening to this song, he navigated to the song 'BINGO" and "Old MacDonald," one of his favorites. He also listened to the Spanish version of it so that when Ingrid came to pick him up, he was happily finishing his bowl of cereal while repeating ‘Buenas noches,’ the phrase that was frequently used and repeated in the song. Santino seems to be gravitating to the Spanish version of late, and I have allowed him to watch and listen as it engages his attention and often elicits spontaneous speech and linguistic patterns. Santino enjoyed finishing his snack while repeatedly viewing 2 or three of the same videos in a looping pattern. All in all, Santino remained in a consistently excellent mood during today's session while working with me.

I worked with Santino again, after his OT session with Christina. We began working where we left off, on a puzzle activity, only this time we worked with a number puzzle, which Santino was able to complete independently. He remained on task for 5 minutes but grew distracted when he heard sounds emanating from an adjacent room, so we took a short break after completing the puzzle. Santino continues to do best when allowed fairly frequent short breaks. He has been increasingly able to tolerate sitting at the classroom table for up to about ten minutes if engaged in a task, or if it is sufficiently challenging without becoming frustrating. Santino is reinforced with verbal praise and physical/sensory-stimulating techniques, minute walks around the room, use of an exercise ball or other physical outlet, and/or allowing him to view or listen to short music apps in which he has demonstrated prior interest. When he is given a signal that we must resume work, he is expected to return his attention to the task at hand and re-directed in a firm voice, if necessary. We went back to working at the table with a large piece of paper and markers to improve Santino's fine-motor coordination and pre-writing skills. He was tasked with using a marker to connect dots to form 3 - 4 inch vertical lines. Santino required hand-over-hand assistance to improve accuracy and to start on top in the correct place on the paper. He persevered on the task until satisfactory completion. He appears to making steady progress and strengthening and improving his visual-motor, bi-manual, and fine-motor development. Furthermore, he understands expectations and is less resistant to working at the table for longer periods of time. His comfort level with me has also steadily improved with time and familiarity to routine, expectations, and structure. Santino indicated he wanted to drink and presented me with his bottle. I used the visual communication book to show him how to string together three - four pictures in order to express his needs (e.g., I want more juice/pudding/puzzle time); however, he did better today when presented with two beverage options, pointing to his desired choice. This pairing between action and image (e.g.; pictures on the board) is hoped to facilitate and foster his language development and sight language cognition. After drinking his bottle, Santino was seated at the table and engaged in some water play. I set up a few objects by the tray filled with warm sudsy water and asked him to put each in the water upon request. Santino did so with a plastic animal, a balloon, a marble, and a cup. As he is manipulated the objects in the water, I provided narration about the properties observed. ("Look, Santino the pig is floating; Look Santino; the marble sank to the bottom.") Santino's mom arrived at the tail end of this activity and Santino helped put on his shoes and socks with minimal verbal and physical prompts, tightening the Velcro closures upon request and thus marking the end to a productive session.

Santino immediately took my hand upon first seeing me enter the classroom today. He led me to his book bag, which I unzipped and took out his food and drink options, narrating everything that I was doing as I was doing it. Santino took out the pudding and I opened it and offered him the spoon to see if he would attempt to feed himself. When he didn’t, I offered him help with feeding, and he allowed me to offer him hand-over-hand assistance to help him hold the spoon and direct it to his mouth. Santino thrust his head backwards upon feeling the spook enter his mouth in a more exaggerated fashion than I have seen him do before. This necessitated smaller spoonfuls of the yogurt so as to minimize the spillage that occurred whenever he pulled away. However, Santino was hungry and did not refuse more to eat when offered. When the OT arrived, she mentioned that she would like to try to see how he eats, as he had never done so for her before, so I left her the few remaining spoonfuls of yogurt and pointed out the other pack should he indicate he wanted more. We finished up by putting pieces back to a farm puzzle we had begun and singing the “Old MacDonald” song, pointing out the animals that were mentioned in the song and prompting Santino to put them in their proper space. He was reinforced for repeating the animals’ names or for closely approximating the word or sound it makes. Santino was instructed to sit back down on the mat and remove his shoes and socks to prepare for his session with the OT. He did so with minimal prompts (gently tapping his shoe and asking him to take off his shoes and socks). He made fleeting eye contact when I called his name to say and wave goodbye.

Santino did very well completing an alphabet puzzle. He also completed a shape puzzle and an animal puzzle. He enjoyed playing with water. He followed instructions, after repetition of movements, and poured the water back and forth between two cups. We went outside very briefly.

We read 'One Fish, Two Fish, Red Fish, Blue Fish' together. Jack enjoyed the rhyming and often guessed the last word of the line by choosing a rhyming word.We talked about what makes words rhyme and named as many rhyming words as we could for -at, -an and -ook. Jack did well determining which two of three short a pictures rhymed. He was able, with minimal help, to state an additional word that rhymed with the two pictures. We practiced short a and short i. Jack did well blending short i words to choose the word that named the pictures. He read, 'The Pig and the Ant' , a book that uses short a and short i words with limited sight words. Jack benefits from encouragement to take his time and blend each sound of the word. Jack did very well with activities based on the concepts of same and different. He worked on writing the numbers 3 and 4, and reviewed the numbers 1 and 2. Jack practiced picture addition. The addition strategy of counting on will be introduced next week. Jack enjoyed a listening skills activity in which he was able to play with and build upon a Lego train. He is dictating a 'chapter story' about the train. We will add to the story a little bit each time until it is complete. Lastly, he worked on 'Math Seeds' practicing picture addition, number line addition and identifying two sets with the same number of objects.

We began the session by having Santino sit on a prescribed area on the carpet in the classroom. He was very engaged with animal blocks, so I removed them all from their box and asked him to hand me the various animals and place each piece, one by one, back into the box upon request. I then had him manipulate the wad of putty and find the hidden farm objects. Santino did so with minimal prompts. As Santino was indoors for two hours with the OT prior to our session today, we took out his visual communication board and Santino picked up the yes tab when asked if he wanted to go outdoors. He required a verbal cue to pick up his socks and moderate physical assistance to put his socks and shoes on. Santino was cooperative and readily complied when asked to give me his hand and walk outside. Once outside, I sprayed Santino with some insect repellent and had him water some of the plants in the garden using a watering can. He required hand-over-hand assistance to do so, as well as prompting cues to direct his eyes back to the plants we were watering if he became unfocused while on task. Santino became distracted when he saw the water slide, which was deflated and hanging over the side of the fence. He tugged on it and vocalized in an impatient fashion indicating he wanted to play in it. I explained that as it was not set up, we could not play on it today, but I easily refocused him onto a nearby sprinkler, which we set up by some plant garden boxes. Santino enjoyed putting his hands through the sprinkler and observing the trajectory of the water. He tried to walk onto the dampened part of the garden box, but he handled my refocusing him well without becoming agitated when diverted from his intended course as he had often done in the past. When we went indoors, Santino independently walked over to the sink and attempted to dispense soap from the dispenser independently. As it is a rather complex multi-step action to do so, requiring one hand to be placed under the dispenser while the other pumps the unit, Santino was afforded physical assistance to complete the task. He also drank some water out of a cup that I brought to his lips but he did not take the cup when handed to him. Once done in the kitchen with our hand-washing routine, we proceeded to the classroom and I afforded Santino moderate assistance to help him change into a pair of dry socks. His mom had requested that he be ready between 2:55 and 3:00 as they had some place to be, and Santino was prepared with his back pack and a ready smile on his face, ready to greet her. He left giggling and in good spirits after a productive day.

Santino was in good spirits today and very responsive to engaging with me during our time together. I began by having Santino sit in a prescribed area and used the massager to signal the start of a new activity and engage his attention and cooperation. This was followed with us using the Boogie Board (Play and Trace Writer). This has a clear colored screen, which allows for tracing activities using a pencil-like stylus with a pointed tip on one end, and a beveled tip on the other, for making both thin and thick lines. This option allows Santino to use whichever tip feels most comfortable and results in the most successful outcomes. We used it today to practice tracing letters and numbers and improve our fine motor skills and coordination. We then used some colorful putty with which to play hide-and-seek. Santino kneaded the putty until he found all 12 farm-themed pieces. I asked, "What sound does a horse make?" and made the sound of whichever animal was revealed after Santino discovered it. The different colors and shapes allow for visual and tactile exploration, color recognition, and serves to facilitate other language activities. We then used a sound machine, and I selected songs I know Santino enjoys. We skipped around the room and Santino was encouraged to mimic my movements and verbalizations. He was reinforced with high fives and enthusiastic words and responses, such as clapping, whenever he did so. Santino then pointed to a yogurt he wished to eat and I afforded him hand-over-hand feeding assistance to do so. We finished our session by using the massager again to signal the end of our session and relax before his departure time. Santino gave me a hug, without solicitation, and left with his mother, in a good mood and happily giggling.

Jack enjoys beginning our time together by listening to a book. Today we read 'Green Eggs and Ham'. He did well predicting what would happen next, determining the feelings of the characters and following the sequence of the story. Jack drew a picture of green eggs and ham and predicted that he would not like them. His word to describe them was disgusting. Jack did well filling in the missing number in a counting sequence. He knew the number, but needed help writing the numbers. We continue to practice writing the numbers 1 and 2 and will begin practicing the number 3 on Friday. We worked on picture addition. We continue to review short i and short a CVC words. Although Jack knows the sounds individually, he will benefit from practice blending the sounds, especially the final sound. Jack was very pleased that he could read a paper book utilizing the short a sound. After a short break outside and a snack, Jack enjoyed working on the 'Math Seeds" lessons, which included picture addition and matching sets of objects to their corresponding numbers.